Integrating Touchscreen-Based Geriatric Assessment and Frailty Screening for Adults With Multiple Myeloma to Drive Personalized Treatment Decisions.

PURPOSE: Geriatric assessment (GA) results predict toxicity/survival in older adults, yet GA is not routinely used in care for patients with multiple myeloma (MM). We tested a tablet-based modified GA (mGA) providing real-time results to clinicians. METHODS: One hundred sixty-five patients with MM aged ≥ 65 years facing a treatment decision from 4 sites completed a tablet-based mGA with Katz Activities of Daily Living (ADL), Lawton Instrumental ADL, Charlson Comorbidity Index, and variables from the Cancer and Aging Research Group's Chemotherapy Toxicity Calculator. Providers reviewed the assessment results at the treatment visit. RESULTS: Patients were white (72%; n = 86), mean age was 72 years (range, 65-85 years), and averaged 7.71 minutes (range, 2-17 minutes) for survey completion. Providers averaged 3.2 minutes (range, 1-10 minutes) to review mGA results. Using International Myeloma Working Group frailty score, patients were fit (39%; n = 64), intermediate fit (33%; n = 55), or frail (28%; n = 46). Providers selected more aggressive treatments in 16.3% of patients and decreased treatment intensity in 34% of patients; treatment intensification was more common for fit patients and milder treatments for frail patients (χ2 = 20.02; P < .0001). Transplant eligibility significantly correlated with fit status and transplant ineligibility with frail status (P = .004). Outcomes on 144 patients 3 months post study visit showed 19.4% (n = 28) had grade ≥ 3 hematologic toxicities, 38.9% (n = 56) had dose modifications, and 18% (n = 26) had early therapy cessation. CONCLUSION: Limited patient time required for survey completion and provider time for results review show mGA can be easily incorporated into clinical workflow. Real-time mGA results indicating fit/frailty status influenced treatment decisions.

Age differences in daily predictors of forgetting to take medication: the importance of context and cognition.

The present study examined age differences in the within-person daily associations of basic cognition, everyday cognition, and busyness with forgetting to take medication. The authors extend previous interindividual difference findings by conducting a daily diary study of a baseline assessment and 8 consecutive days of 40 older adults (age = 60-89 years, M = 74.86) and 31 younger adults (age = 18-20 years, M = 18.30) where basic cognition, everyday cognition, busyness, and forgetting medication were assessed each day and entered simultaneously into one model. Results from a logistic multilevel model indicated that performance on Letter Series was beneficial for both age groups, but the role of fluctuations in busyness on forgetting to take medications was opposite for younger and older adults. Younger adults remembered to take their medication the most on days when they had high everyday cognition and were busier. Older adults remembered to take their medication the most on days when they had high everyday cognition but were less busy. These findings highlight the importance of contextual variation in busyness in relation to daily medication adherence for younger and older adults.